Overcrowded Limerick A&E is a 'work in progress', report finds

'Patient experience times (PETs) and the time spent waiting for tests were raised by patients in the emergency department as areas of great frustration', Hiqa report found

Patients told inspectors that being on trolleys in corridors was 'not dignified or private'. Picture: Dan Linehan

Health watchdog Hiqa said conditions for patients at the emergency department in University Hospital Limerick have improved but it remains “ a work in progress” following its latest inspection.

One patient spent four days in the emergency department (ED) waiting on an MRI scan and seven days waiting for an electroencephalogram. 

Some 14 of 25 patients on trolleys in the Acute Medical Unit had been there for more than five days.

“Patient experience times (PETs) and the time spent waiting for tests were raised by patients in the emergency department as areas of great frustration,” the report states.

Patients told inspectors that being on trolleys in corridors was “not dignified or private”. Patients also said “staff were overworked”.

While inspectors found the emergency department was “generally observed to be clean and well-maintained” they also noted “a significant infection prevention and control risk for patients” caused by placing trolleys too closely together.

They found while patients were spending less time in the ED now the time between the decision to admit someone and finding them a bed ranged from 47 minutes to 7,945 minutes (132 hours or 5.5 days).

The hospital was found to be partially compliant with three national standards and non-compliant with one standard in the ED.

This compares with last year, when the hospital was non-compliant with three of four standards and only partially compliant with the fourth.

“Notwithstanding these findings, the emergency department remained very overcrowded, with 72 patients on trolleys and chairs awaiting an inpatient bed,” Hiqa said of February 21 and 22.

This level of overcrowding continued to impact on the privacy and dignity of patients despite the best efforts of staff — albeit a number of the risk issues Hiqa found in 2022 had been addressed.” 

The inspectors found: “The hospital and wider HSE also fully acknowledged that improvement efforts to address ED overcrowding remain a work in progress.” 

Inspectors noted bed capacity was a challenge, with the first of two under-construction 96-bed blocks not opening until late next year at the earliest. Picture: Sasko Lazarov/RollingNews.ie

Patients coming to the ED are being treated faster and staying there for less time, more nurses and consultants in emergency medicine have been hired with new rosters in place.

“It is imperative that these gains are built on and further efficiencies are achieved,” Hiqa urged.

The wider hospital was assessed against 11 standards and found to be either compliant or substantially compliant with eight of the 11.

Inspectors found between 19 and 27 patients every day faced discharge delays and said “the longest waiting time being 247 days".

However, they found these delays were less of a problem than in other large hospitals.

Inspectors noted bed capacity was a challenge, with the first of two under-construction 96-bed blocks not opening until late next year at the earliest.

Older patients are benefiting from alternative care pathways, and these need to be further developed. Also, more efforts are needed to fill vacant jobs at the hospital.

The hospital has ordered extra ED equipment for October, including Omnicell drug-dispensing system, ECG machines and pressure-relieving mattresses for trolleys.

Hiqa also met with local GPs, community healthcare services and with senior HSE management to confirm supports from them. The health watchdog said a whole-region plan for the Mid-West, covering Limerick, Clare, and North Tipperary, was needed across hospitals, community, and GP services.